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This study reports the results of an online survey carried out by the Portuguese Society of Cardiology about its medical members’ work characteristics before and during the COVID-19 pandemic, their job satisfaction, work motivation, and burnout.

To characterize patients with atherosclerosis, a disease with a high socioeconomic impact, in the Lisbon and Tagus Valley Health Region.

A Internet é fundamental na divulgação de informação médica. Contudo, a ausência de controlo de qualidade potencia a “desinformação” da população. Pretendemos caraterizar a relevância e qualidade da informação sobre enfarte agudo do miocárdio em língua portuguesa no site YouTube (www.youtube.com).

Atrial fibrillation (AF), the most common arrhythmia in the adult population worldwide, represents a significant burden in terms of cardiovascular mortality and morbidity and has repercussions on health economics. Oral anticoagulation (OAC) is key to stroke prevention in AF and, in recent years, results from landmark clinical trials of non-vitamin K oral anticoagulants (NOAC) have triggered a paradigm shift in thrombocardiology. Despite these advances, there is still a significant residual vascular risk associated with silent AF, bleeding, premature sudden death and heart failure.

As doenças cardiovasculares são a principal causa de morte em Portugal, sendo a aterosclerose o processo fisiopatológico subjacente mais comum. O objetivo deste estudo foi quantificar o impacto económico da aterosclerose em Portugal através da estimação dos custos associados.

Nos últimos anos, temos assistido a um aumento do número de doentes com necessidade de cuidados cardíacos agudos, com patologia cardiovascular progressivamente mais complexa, muitas vezes complicada por comorbilidades não cardiovasculares agudas ou crónicas, com impacto na abordagem e prognóstico destes doentes. As unidades coronárias têm evoluído para unidades de cuidados intensivos cardíacos, caracterizadas por cuidados de saúde altamente especializados ao doente cardíaco crítico. Tendo em conta que os recursos humanos e técnicos nesta área são limitados, considerámos ser urgente uma reflexão profunda sobre o modelo de organização dos cuidados ao doente cardíaco agudo, incluindo a definição do nível de cuidados, a constituição e formação da equipa e a criação de redes de referenciação.

Coronary artery disease is becoming the leading cause of death in women in Western society. However, the available data shows that women are still underdiagnosed and undertreated with guideline-recommended secondary prevention therapy, leading to a significantly higher rate of in-hospital complications and in-hospital mortality.

Even with improvements in lifestyle interventions, better control of cardiovascular (CV) risk factors, and improvements in CV outcomes, cardiovascular disease (CVD) remains the leading cause of morbidity and mortality in Portugal and Europe. Atherogenic dyslipidemias, particularly hypercholesterolemia, have a crucial causal role in the development of atherosclerotic CVD. The clinical approach to a patient with dyslipidemia requires an accurate diagnosis, based on harmonized and standardized lipid and lipoprotein laboratory assessments. Results and reports of these tests, together with assessment of total CV risk and the respective therapeutic targets, will help ensure that clinical guidelines and good clinical practices are followed, increasing the reliability of screening for lipid disorders, producing more accurate diagnoses and CV risk stratification, and improving CV prevention. To this end, this consensus aims to provide clinicians with practical guidance for the harmonization and standardization of laboratory lipid tests, focusing on the most recent dyslipidemia management guidelines.

We report a case of sarcoidosis with an unusual presentation, initially manifesting as bilateral pulmonary embolism and then as a cardiac form of the disease with an ominous clinical event consisting of sustained ventricular tachycardia. The diagnosis was established by clinical and magnetic resonance criteria despite normal conventional echocardiographic study. Detailed functional assessment provided by tracking techniques (speckle tracking echocardiography and cardiac magnetic resonance tissue tracking) enabled the detection of regional deformation abnormalities, indicating prominent circumferential strain and epicardial layer alterations, partly matching the structural changes depicted by distribution of delayed enhancement.

The role of endothelial dysfunction (ED) in patients with ST-elevation myocardial infarction (STEMI) is poorly understood. Peripheral arterial tonometry (PAT) allows non-invasive evaluation of ED, but has never been used for this purpose early after primary percutaneous coronary intervention (P-PCI). Our purpose was to analyze the relation between ED assessed by PAT and both the presence of microvascular obstruction (MVO) and infarct extension in STEMI patients.

In this study, we performed an extensive exploration of the ligand entry mechanism for members of the steroid nuclear hormone receptor family (androgen receptor, estrogen receptor α, glucocorticoid receptor, mineralocorticoid receptor, and progesterone receptor) and their endogenous ligands. The exploration revealed a shared entry path through the helix 3, 7, and 11 regions. Examination of the x-ray structures of the receptor-ligand complexes further showed two distinct folds of the helix 6–7 region, classified as “open” and “closed”, which could potentially affect ligand binding. To improve sampling of the helix 6–7 loop, we incorporated motion modes based on principal component analysis of existing crystal structures of the receptors and applied them to the protein-ligand sampling. A detailed comparison with the anisotropic network model (an elastic network model) highlights the importance of flexibility in the entrance region. While the binding (interaction) energy of individual simulations can be used to score different ligands, extensive sampling further allows us to predict absolute binding free energies and analyze reaction kinetics using Markov state models and Perron-cluster cluster analysis, respectively. The predicted relative binding free energies for three ligands binding to the progesterone receptor are in very good agreement with experimental results and the Perron-cluster cluster analysis highlighted the importance of a peripheral binding site. Our analysis revealed that the flexibility of the helix 3, 7, and 11 regions represents the most important factor for ligand binding. Furthermore, the hydrophobicity of the ligand influences the transition between the peripheral and the active binding site.

Introdução e objetivos: Os dados epidemiológicos atuais sobre insuficiência cardíaca (IC) em Portugal provêm de estudos realizados há mais de duas décadas. O objetivo principal deste estudo é determinar a prevalência da síndrome de IC na população portuguesa com 50 ou mais anos de idade, sendo, especificamente, objetivo deste artigo descrever as abordagens metodológicas e o protocolo de investigação aplicados.

O pseudoaneurisma do ventrículo esquerdo é uma complicação rara do enfarte agudo do miocárdio, associada a elevada mortalidade. No entanto, pode manifestar‐se de modo inespecífico, dificultando e atrasando o seu diagnóstico.

ABSTRACTTick-borne encephalitis virus (TBEV) is a leading cause of human neuroinfections in Europe and Northeast Asia. There are no antiviral therapies for treating TBEV infection. A series of nucleoside analogues was tested for the ability to inhibit the replication of TBEV in porcine kidney cells and human neuroblastoma cells. The interactions of three nucleoside analogues with viral polymerase were simulated using advanced computational methods. The nucleoside analogues 7-deaza-2′-C-methyladenosine (7-deaza-2′-CMA), 2′-C-methyladenosine (2′-CMA), and 2′-C-methylcytidine (2′-CMC) inhibited TBEV replication. These compounds showed dose-dependent inhibition of TBEV-induced cytopathic effects, TBEV replication (50% effective concentrations [EC50]of 5.1 ± 0.4 μM for 7-deaza-2′-CMA, 7.1 ± 1.2 μM for 2′-CMA, and 14.2 ± 1.9 μM for 2′-CMC) and viral antigen production. Notably, 2′-CMC was relatively cytotoxic to porcine kidney cells (50% cytotoxic concentration [CC50] of ∼50 μM). The anti-TBEV effect of 2′-CMA in cell culture diminished gradually after day 3 posttreatment. 7-Deaza-2′-CMA showed no detectable cellular toxicity (CC50> 50 μM), and the antiviral effect in culture was stable for >6 days posttreatment. Computational molecular analyses revealed that compared to the other two compounds, 7-deaza-2′-CMA formed a large cluster near the active site of the TBEV polymerase. High antiviral activity and low cytotoxicity suggest that 7-deaza-2′-CMA is a promising candidate for further investigation as a potential therapeutic agent in treating TBEV infection.

La terapia de resincronización cardiaca con desfibrilador aumenta la supervivencia y mejora la calidad de vida en insuficiencia cardiaca avanzada. Tradicionalmente, se ha excluido a los pacientes con fracción de eyección >35% calculada por ecocardiografía. Evaluamos el impacto pronóstico de dicha terapia en un grupo de pacientes con disfunción sistólica grave por ecocardiografía pero con fracción de eyección >35% por resonancia magnética cardiaca.

Patients with acute heart failure (AHF) are frequently evaluated in the Emergency Departments (ED) and discharged from their observation units (OU) without hospital admission. We examined direct discharge rates from the ED OU, risk factors for returning to the ED, and returning and mortality rates.

Em Portugal, até 38% da população sofre de doença cardiovascular, o que salienta a importância dos cuidados de saúde primários (CSP) na sua gestão.A gestão adequada da pessoa com doença cardiovascular obriga frequentemente à referenciação hospitalar para consulta de cardiologia. Contudo, nem sempre é fácil distinguir quais as situações mais prementes, principalmente tendo em conta que os CSP não têm acesso a todos os exames complementares de diagnóstico recomendados pelas guidelinesinternacionais, como por exemplo péptidos natriuréticos na insuficiência cardíaca ou angiografia por tomografia computorizada cardíaca nas síndromes coronárias crónicas, entre outros.O objetivo deste documento é descrever uma abordagem prática às patologias do foro cardiológico mais frequentes que podem requerer uma referenciação para consulta hospitalar de cardiologia. Assim, nos diferentes capítulos são destacadas as recomendações de referenciação de forma genérica, por grupo de patologias, bem como, ainda que de forma sucinta, a abordagem clínica inicial no âmbito dos CSP para um diagnóstico diferencial e acompanhamento crónico mais eficiente.Foi utilizada uma metodologia Metaplan modificada reunindo um painel de quatro especialistas em Cardiologia e três especialistas em Medicina Geral e Familiar que desenvolveram este documento, o qual deve ser entendido não como uma norma oficial, mas sim como um instrumento de orientação adicional para o correto encaminhamento dos doentes. É por isso aconselhada a validação local destas recomendações com o hospital de referência, bem como a leitura das respetivas guidelinesinternacionais e nacionais.

OBJECTIVE: To analyze the clinical characteristics of patients from a Department of Autoimmune Diseases presenting chronic hepatitis C virus (HCV) infection, systemic autoimmune disease, and B cell lymphoma. METHODS: We analyzed the records of 100 consecutive patients with systemic autoimmune diseases and associated HCV infection seen in our department between 1994 and 2000. We retrospectively investigated the development of B cell malignancies after the diagnosis of HCV related autoimmune disease. RESULTS: Six patients with HCV related systemic autoimmune disease presented B cell non-Hodgkin's lymphoma (NHL). These patients fulfilled the diagnostic criteria for Sjögren's syndrome (n = 4) and polyarteritis nodosa (PAN; n = 2). Four patients were female and 2 male, with a mean age at lymphoma diagnosis of 62 years (range 45–78). The main immunologic markers were hypocomplementemia in all patients and cryoglobulinemia in 5 (83%). Primary extranodal localization of lymphoma was observed in 3 (50%) patients: prostate (n = 1), liver and ovary (n = 1), and ocular annexa (n = 1). Clinically, NHL was classified as indolent lymphoma in 3 patients and aggressive lymphoma in 3. NHL histologic types were diffuse large cell lymphoma (n = 4), extranodal marginal zone B cell lymphoma (n = 1), MALT lymphoma (n = 1), and lymphoplasmacytic lymphoma (n = 1). CONCLUSION: We describe 6 patients with a triple association of HCV infection, systemic autoimmune disease, and NHL. Characteristics of these patients included a high prevalence of cryoglobulinemia (that clearly contributes to fulfilment of diagnostic criteria for PAN) and an elevated frequency of primary extranodal involvement. We recommend careful evaluation of patients with B cell NHL to detect silent autoimmune or chronic viral diseases. This triple association reinforces the suspected links between autoimmunity, infection, and cancer.

By using multinuclear (1H, 13C, 17O, 95Mo, 183W) magnetic resonance spectroscopy (1D and 2D), quinic acid is found to form 2 homologous complexes with both tungsten(vi) and molybdenum(vi), in aqueous solution. Two isomeric 1 ∶ 2 (metal ∶ ligand) complexes involving the carboxylate and the adjacent OH groups are present in the pH range 2–11. One of the W(vi) complexes with quinic acid, WO₂(C₇H₁₀O₆)₂2− has been isolated in the solid state and characterised by X-ray diffraction, the tungsten atom being six-coordinated in an approximate square bipyramidal geometry. This structure is identical to that proposed for the most stable complex in solution. In the presence of hydrogen peroxide and with both metals, quinic acid forms one 1 ∶ 1 ∶ 2 (metal ∶ ligand ∶ peroxide) species, also involving the carboxylate and the adjacent OH groups.

OBJECTIVE: To determine the prevalence of Raynaud's phenomenon (RP) in a large series of patients with primary Sjögren's syndrome (SS) and to identify the clinical and immunological features related to its presence. METHODS: In a cross sectional study, we investigated 320 consecutive patients with primary SS (294 women, 26 men; mean age at onset 60 yrs, range 16-87 yrs). All patients fulfilled 4 or more of the diagnostic criteria for SS proposed by the European Community Study Group in 1993. Diagnosis of RP in patients with SS was defined as intermittent attacks of digital pallor and/or cyanosis in the absence of any other associated disease or anatomical abnormalities. RESULTS: RP was present in 40 (13%) patients. All were women, with a mean age of 57 yrs (range 18-78). RP preceded onset of sicca symptomatology in 18 (45%) patients. The main triggering factor was exposure to cold, which induced RP in all patients, while emotional stress was a factor in 12 patients, as was job related predisposition in 2. Fifteen (38%) patients required pharmacological treatment with calcium channel blockers (12 patients) or angiotensin converting enzyme inhibitors (2 patients) during colder months, and one patient required treatment with intravenous prostacyclin for ischemic complications. Compared with SS patients without RP, those with RP showed a higher prevalence of articular involvement (50 vs 31%; p = 0.031), cutaneous vasculitis (30 vs 11%; p = 0.003), antinuclear antibodies (95 vs 65%; p < 0.001), anti-Ro/SSA (59 vs 31%; p < 0.001) and anti-La/SSB antibodies (44 vs 20%, p = 0.003). CONCLUSION: We found RP in 13% of patients with primary SS, in almost half of whom RP was the first autoimmune symptomatology. These patients constituted a subset of SS with a higher frequency of some extraglandular features and positive immunological markers. The clinical course of RP seems to be milder in patients with primary SS than in those with other systemic autoimmune diseases such as systemic sclerosis, with no vascular complications and pharmacological treatment needed in only 40% of patients.

A multinuclear (¹H, ¹³C, ¹⁷O, ⁵¹V) 1D and 2D NMR study of the complexation of L-lactic acid with vanadium(V) and hydrogen peroxide shows that four peroxo complexes are formed in aqueous solution in the pH range 1−7. Two isomeric 2:2:1 (metal:ligand:peroxo) complexes, together with a 2:2:2 species, are found over the entire pH range. At pH values below 2 an additional 1:1:1 complex is formed. The acid was found in all cases to act as a bidentate ligand through the carboxylic and the adjacent hydroxyl groups. To the best of our knowledge, this is the first report of dinuclear peroxovanadium complexes in which one of the metal centres is an oxovanadium centre (2:2:1 species).

By using multinuclear ¹H, ¹³C, ¹⁷O, ⁹⁵Mo and ¹⁸³W magnetic resonance spectroscopy (1-D and 2-D), aldonic acids, alduronic acids and aldaric acids have been found respectively to form one, four and three homologous oxoperoxo complexes with Mo^VI and W^VI, in aqueous solution (pH range 2–11). Common features are the involvement of two peroxide units per metal centre and the co-ordination of the sugar acids through carboxylate and adjacent hydroxyl groups. Accordingly, 1∶1∶2 (metal∶acid∶peroxide) complexes are detected as well as 2∶1∶4 species in the case of the aldaric acids. The geometry around each MO⁴⁺ centre is approximately pentagonal bipyramidal, the M&z.dbd6;O group occupying one of the apical positions and the two peroxo ligands being equatorial. The sugar acid is co-ordinated in one equatorial and in one apical site.

A critical appraisal is made of the validity of the rotational isomeric state (RIS) approximation in studies of rotational isomerism, especially as far as the determination of energy differences for the stable conformers is concerned. By using simple model potential energy functions for internal rotation appropriate to some ethane derivatives, a comparison is made between the thermodynamic parameters that can be extracted from such potential functions and those obtained by applying the RIS method to continuum averaged values of conformation dependent properties. The effects due to the form of this conformation dependence, to the features of the potential energy curve, and to the temperature are discussed. The errors can be very large for realistic situations, and variable with temperature and with the property being studied; cases for which the errors are small are usually accidental.

Vicinal H—H and C—H coupling constants are reported for (+)-tartaric acid and meso-tartaric acid at various pH values and used in a discussion of the conformation of these molecules. This is found not to change much with pH. For the mesoform, in particular, the most favoured conformer is determined not so much by the possibility of internai hydrogen bonding but, at least in part, by stabilization of polar conformations in a sol vent (H2O) of high dielectric constant.

Kinetics of water exchange of bis(nitrato)diaquodioxouranium(VI) in 96.7% acetone-water have been studied by 1H NMR spectroscopy, and the activation parameters ΔH* = 21.0 kJ mol-1, ΔS* = -86.5 J K-1 mol-1 determined.

Complex formation between molybdate ions and R,R-(+)-tartaric acid has been studied in aqueous solution, and to a limited extent in DMSO, over a range of concentrations and pH at 298K, using1H and13C n.m.r. techniques. Only four main species are evident; two, which have Mo: L ratios of 1:1 and 1:2, are bondedvia a carboxylic oxygen atom and an adjacent hydroxyl oxygen atom. The 1:2 species forms stereospecifically. The other two main species contain bridging tartaric acid molecules, and a 2:2 species, also formed stereo-specifically in solution, have been isolated and characterised in the solid state. A limited number of experiments with racemic acid and meso-tartaric acid indicate that only a few species are formed in these systems and with a good deal of stereospecificity also.

The coordination compounds formed between W(VI) and D-galactaric and D-mannaric acids, in aqueous solution, have been studied by 1H, 13C, 17O and 183W NMR spectroscopy. In the pH range 3-8 for D-galactaric acid and 2-10 for D-mannaric acid, the acids are found to form n:n species (mainly 2:2) with tungstate, in which the ligands are bound to the metal by the two carboxylate groups and their adjacent OH groups. Above pH 6.5, a 2:1 species is also formed, in which all the OH functions are coordinated to the metal, the two carboxylate groups remaining free. The formation of symmetrical or asymmetrical species is discussed, taking into account the configuration of the ligands. Structures for the various complexes are formulated.

By using simple model potential energy functions for internal rotation of ethane derivatives (CH2X–CH2X and CHX2–CHX2), a comparison was made between the continuum and the rotational isomeric state models for obtaining conformation information (especially energy differences for the staggered conformers) from electric dipole moments. It is found that the results obtained by the two procedures may be appreciably different, depending on the features of the conformational energy function and on the temperature considered.

A full pH range 1H and 13C nmr study was performed of the complexation of UO22+with malic acid, for variable concentrations and molar ratios. Spectral evidence for the existence of at least five complexes was found, and their stoichiometry and dependence on pH were investigated. Information on the conformation of the bound ligand molecules was also obtained.

Proton and carbon-13 nmr evidence is presented on the number, stoichiometry, geometry, and stability of the complexes which form when sodium tungstate and (D,L)-thiomalic acid are mixed in aqueous solution at pH values in the range 2–7. In particular, three (or four) complexes are detected having a 1:2 composition (metal–ligand), as well as a less stable complex which seems to be a 1:1 species. Preliminary data are also given on the exchange of bound ligand in these complexes.

A proton, carbon-13, and vanadium-51 nuclear magnetic resonance study is reported on the number, stoichiometry, geometry, and relative stability of the complexes that form when vanadate(V) solutions are mixed with each one of the following organic α-hydroxyacids in the pH range ~2.5 – ~7: glycolic, lactic, chloro-3- and phenyl-3-lactic, mandelic, glyceric, and malic acids. The predominant complexes have 1:1 composition (almost certainly in a polymeric structure) in contrast with the 1:2 (metal:ligand) stoichiometry of the corresponding Mo(VI) and W(VI) complexes.

A proton and carbon-13 nuclear magnetic resonance study is reported on the number, stoichiometry, geometry, and stability of the complexes that form when sodium tungstate or sodium molybdate is mixed with each one of the following α-hydroxyacids in aqueous solution at pH values in the range 3–8: glycolic, lactic, chloro-3- andphenyl-3-lactic, mandelic, and glyceric acids. The predominant complexes have 1:2 composition and pKof formation of the order of −5 to −16.

A test was devised involving familiar chemical examples and administered to samples of Portuguese university chemistry students in order to establish to what extent they recognised and correctly assessed the explanatory content of statements presented in the form of justifications, usually beginning with the word 'because'. It was found that a high percentage of the students selected as the 'best explanations' statements that either involved tautology or simply invoked a rule, principle or general observation. Also, low-level interpretations and correlations between facts and/or variables (or mathematical concepts) were also frequently taken as valid explanations; more surprising, however, was the finding that a significant proportion of statements involving high level interpretation in terms of fundamental concepts were rated as providing the least intellectual satisfaction.

Background: The presence of complete left bundle branch block (LBBB) is commonly associated with a poorer prognosis, especially in patients with coronary artery disease (CAD). In the general population with suspected CAD and normal intraventricular conduction, a normal dipyridamole-thallium scintigraphy is a strong marker of a favorable outcome. Objective: Our objective was to assess the prognosis in patients with LBBB and a normal dipyridamole thallium-201 scintigram. Population and methods: Patients with complete LBBB and normal myocardial perfusion on dipyridamole SPECT thallium-201 scintigraphy performed in our center for suspected CAD between 1988 and 1995 were monitored for clinical events. Results: Sixty-nine patients (36 women and 33 men) with a mean age of 59 years (range 56 to 61) were monitored for a mean period of 33 months (range 25 to 35). During this period, 4 patients had unstable angina, 2 of whom underwent myocardial revascularization. There were no deaths or myocardial infarction. All events occurred at least 2 years after the thallium-201 scintigraphy. Conclusion: The presence of a normal myocardial perfusion with dipyridamole thallium-201 scintigraphy in this group of patients with suspected CAD and LBBB was associated with a very good prognosis, a low rate of clinical events occurring only 2 years after the myocardial scintigraphy, and no hard events.

The complexation of molybdenum(VI) by L-aspartate in dilute aqueous solutions, at pH 6, was studied using u.v. spectrophotometry,1H and13C n.m.r. spectroscopy. A single complex anion, [MoO3(C4H5NO4)]2-, is observed in solution. The conformation of the aspartate ion in the complex was determined and shown to be consistent with it acting as a terdentate ligand. The formation constant of the complex was determined at different ionic strengths. Job's method has been employed, here and elsewhere, to study the stoichiometry of the complex. However, the result is strongly affected by polymerization of molybdenum(VI): this effect is discussed.

[Ru(TPT)2]2+ undergoes nucleophilic attack at the ligand in aqueous solutions of HO-. The reaction is reversible and the equilibrium can be followed spectrophotometrically. In acid solution, the free nitrogen atoms of the uncoordinated pyridine residues are protonated to form a new species. Two reactions of [Fe(TPT)2]2+ take place in H2O over extended periods. The first is the well-known dissociative process, but the second appears to involve reaction at the ligand. The results are used to reinterpret some of the chemistry of complexes of TPT and related ligands.

Following earlier theoretical studies of orbital delocalization effects on one-bond 13C-H coupling constants (1JCH) an approximate proportionality of (1JCH) to ?3/2, where ? is the s-character of the carbon hybrid orbital appropriate to the construction of the best localized molecular orbitals, is predicted and verified by using published data. It is proposed that this proportionality should replace the previous linear correlations of (1JCH) with ?, which involve large additive constants.